• Dr Peter Chew

Tuberculosis and pregnancy

Tuberculosis (TB) is a disease caused by the organism, Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can affect other parts of the body. The disease can be in an inactive phase (latent infection) when the patient remains asymptomatic or may progress to an active stage, when it can spread through the air.

For women in the reproductive age, TB can present great challenges before, during and after pregnancy.

TB can cause infertility in women. The bacteria can affect the fallopian tubes leading to inflammation and subsequent blockage.

During pregnancy, TB may present a challenge in diagnosis. The initial symptoms may mimic those of viral “flu” with cough, fever and lethargy. As TB is relatively uncommon in Singapore, if the symptoms persist for more than 2 weeks, one should keep the diagnosis of TB in mind. The sputum should be sent for smear and culture. A chest X-ray may be done after putting a lead shield over the abdomen to prevent the harmful effects of radiation on the baby. Tuberculin skin test should be done as it is considered safe throughout pregnancy.

Pregnant women who have active tuberculosis should be treated as TB is a deadly disease. For the baby, intrauterine growth restriction may occur if the mother is not treated. In rare cases, the baby may develop TB.

The standard first line drugs are safe and do not harm the baby and patients. The pregnant woman should be monitored with liver function tests and visual fields at periodic intervals.

After delivery, mothers may be worried whether they should breast feed their babies. Those who choose to breastfeed and are still undergoing TB treatment can safely do so. Very small amounts of the medication may pass to the baby through the breast milk but the amounts are too small to produce toxicity. It is Important that the mother should put a mask on while breast feeding.

With increasing affluence and improved socio-economic status, the number of patients suffering from TB in Singapore is small. Following the launch of the Singapore Tuberculosis Elimination Programme (STEP) in 1997, the number of TB cases has declined and fluctuated between 35 to 45 cases per 100,000 population among Singapore residents. In 2016, there were 1,617 new cases of TB and majority were male aged 50 and above.

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